Eight strategic elements that support successful implementation of beneficial nutritional interventions in the perioperative setting: A systematic review

Background and aims: Research findings are often difficult to implement into daily practice. This systematic review aimed to identify elements of implementation strategies for perioperative nutritional interventions supporting successful adoption in daily practice. Methods: We conducted a comprehensive search in PubMed, Embase (Ovid), Cochrane Library and CINAHL (EBSCO) databases. The search entailed articles including adult patients and describing successful implementation strategies of beneficial nutritional interventions in the perioperative setting, published up to July 2024. Given the descriptive nature of the outcomes, a meta-analysis was not deemed feasible, thus we performed a qualitative data analysis. Results: Out of 3070 articles screened, thirteen studies were included in our review. Several successful elements of implementation strategies were identified: I. providing team training for a new protocol, II. appointing a leader with clear responsibility, III. conducting audits of the process, IV. inclusion of pre-identified barriers, V. implementation guidance by a defined framework, VI. working with visual aids, VII. creating an order set in electronic medical records, and VIII. learning from peers with practical experience. Successful implementation of a beneficial perioperative nutritional intervention was seen when all or a part of these identified successful strategies were combined. All studies had at least one methodological weakness based on the risk of bias assessment. We observed that the studies which explicitly pre-defined barriers, often employed strategies to directly target those barriers. Conclusions: This review revealed eight strategic elements that support successful implementation of beneficial nutritional interventions in the perioperative setting. Incorporating these strategic elements should be considered to enhance implementation into clinical practice. Prospero number: CRD42023465224.